Correction of Antithrombin III Deficiency in Disseminated Intravascular Coagulation
https://doi.org/10.15360/1813-9779-2008-5-49
Abstract
Although antithrombin (AT) III concentrate therapy is attended by an increased risk of hemorrhage, the data available in the literature suggest that the agent may have a positive effect on outcome in disseminated intravascular coagulation (DIC). Administration of fresh frozen plasma (FFP) is associated with a less risk of hemorrhage; however, there is no evidence for its impact on prognosis in DIC. Objective: to compare the effects of AT concentrate and FFP on the activity of AT and on the clinical course of DIC. Subjects and methods. Forty-three patients diagnosed as having as DIC (according to the JAAM scale) and <70% AT deficiency were included into a randomized clinical study. The inclusion criteria were as follows: age less than 16 years and more than 75 years; malignancy; hemorrhage; hemostatic therapy; a thrombocytopenia of <50X109/l. The patients were randomized into 3 groups: A) AT concentrate 500— 1000 IU/day; B) FFP 10 ml/kg/day; C) combined therapy. The agents were daily administered for 4 days in a persistent AT deficiency of 70%. Nadroparin, 95 IU AXa/kg/day, was used as concurrent therapy. Results. The activity of AT substantially increased in Group A and great differences between Groups A and B preserved during therapy: 69±16 and 51±14% (p=0.007); 72±18 and 56±13% (p=0.02); 73±14 and 57±16% (p=0.03), respectively. No significant differences were found in the severity of respiratory disorders, dysfunction of other organs, DIC scale scores, the incidence of hemorrhages (2 cases in Group A), allergic reactions (2 cases of urticaria in Group C) and in 30-day mortality — 40, 53.3, and 30.8% in Groups A, B, and C, respectively. Conclusion. As compared with FFP and combined therapy, AT concentrate therapy for DIC provides a more effective correction of AT deficiency. Further studies are needed to compare the impact of three therapy modalities on the outcome and incidence of complications in DIC. Key words: disseminated intravascular coagulation (DIC), diagnostic criteria for DIC, antithrombin III deficiency, antithrombin III concentrate, fresh frozen plasma.
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For citations:
Neporada Ye.L., Vorobyeva N.A., Nedashkovsky E.V. Correction of Antithrombin III Deficiency in Disseminated Intravascular Coagulation . General Reanimatology. 2008;4(5):49. (In Russ.) https://doi.org/10.15360/1813-9779-2008-5-49
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